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COVID-19 and Gastrointestinal Tract: From Pathophysiology to Clinical Manifestations
Filippo Vernia1, Hassan Ashktorab2, Nicola Cesaro1
1Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy.
Insights
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) directly infects the gastrointestinal tract, causing symptoms like diarrhea and nausea. Understanding this interaction is crucial for managing COVID-19, even with vaccination.
Area of Science:
- Gastroenterology
- Virology
- Infectious Diseases
Background:
- COVID-19 pandemic, caused by SARS-CoV-2, impacts millions globally.
- While primarily respiratory, COVID-19 frequently presents with gastrointestinal symptoms.
- Gastrointestinal manifestations of COVID-19 require further investigation.
Purpose of the Study:
- To review the pathophysiology of gastrointestinal COVID-19.
- To outline the clinical manifestations of gastrointestinal COVID-19.
- To synthesize current knowledge on SARS-CoV-2's gastrointestinal effects.
Main Methods:
- Systematic electronic literature search up to January 2023.
- Databases searched include Medline, Scopus, and Cochrane Library.
- Focus on studies investigating SARS-CoV-2's role in the gastrointestinal tract.
Main Results:
- SARS-CoV-2 directly infects the gastrointestinal tract.
- Common symptoms include diarrhea, nausea, vomiting, abdominal pain, anorexia, and altered taste.
- Pathological changes involve mucosal damage, inflammation, and altered gut microbiota.
- Viral mechanisms for overcoming gastric acidity are under investigation.
Conclusions:
- Gastrointestinal symptoms can occur despite vaccination, indicating potential long-term viral interactions.
- Understanding SARS-CoV-2's gastrointestinal impact is vital for patient management.
- Further research is needed on the long-term consequences of gastrointestinal SARS-CoV-2 infection.
Abstract:
Background: Since its first report in Wuhan, China, in December 2019, COVID-19 has become a pandemic, affecting millions of people worldwide. Although the virus primarily affects the respiratory tract, gastrointestinal symptoms are also common. The aim of this narrative review is to provide an overview of the pathophysiology and clinical manifestations of gastrointestinal COVID-19. Methods: We conducted a systematic electronic search of English literature up to January 2023 using Medline, Scopus, and the Cochrane Library, focusing on papers that analyzed the role of SARS-CoV-2 in the gastrointestinal tract. Results: Our review highlights that SARS-CoV-2 directly infects the gastrointestinal tract and can cause symptoms such as diarrhea, nausea/vomiting, abdominal pain, anorexia, loss of taste, and increased liver enzymes. These symptoms result from mucosal barrier damage, inflammation, and changes in the microbiota composition. The exact mechanism of how the virus overcomes the acid gastric environment and leads to the intestinal damage is still being studied. Conclusions: Although vaccination has increased the prevalence of less severe symptoms, the long-term interaction with SARS-CoV-2 remains a concern. Understanding the interplay between SARS-CoV-2 and the gastrointestinal tract is essential for future management of the virus.
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